FCJPUU: Volunteer Application for Working with Children and Youth

Thank you for your interest in working with the children and youth of our congregation! Our congregation takes seriously our responsibility of assuring the safety of our youth. Please fill out this form and the Minister and/or Office & Facilities Administrator will be in touch! All volunteers who work directly with children must meet with the Minister and have attended FCJPUU or another UU church for six months. Thank you for your support in providing a safe and secure environment for all of the congregation’s children and youth.

Contact Information

Name

Phone

Address

How would you like to help?

Childcare during Sunday services Childcare/activities on select Saturday afternoons Other: lead an activity, share a skill, read story with children or assist with special events (holiday pageant, Easter egg hunt). Other suggestions are welcome!

Experience and History

Please describe any previous work or other experience you have had with children:

Please list two references (who are not relatives) who have known you for at least two years and who are familiar with your character as it pertains to your experience with children or youth, including their name, relationship to you, email address, and phone number:

Have you attended FCJPUU for six months or longer?

Yes No

Have you previously been associated with another UU church? If so, please list the church and location below. If you are not a current member of FCJPUU, please also include contact information for a staff member at your previous church:

Background and Releases

Note: While we must perform a criminal background check for all volunteers, interaction with the criminal justice system does not automatically disqualify someone from volunteering: results will be discussed with the Minister and/or Board leaders and evaluated on a case-by-case basis.

Have you ever been accused of any crimes against a person, including rape, incest, sexual exploitation of a minor, or sexual or physical assault of a minor?

Yes No

Have you ever been convicted of any crimes against a person, including rape, incest, sexual exploitation of a minor, or sexual or physical assault of a minor?

Yes No

Have you ever resigned from employment or been disciplined or terminated by any employer for reasons related to sexual misconduct or child abuse?

Yes No

Other than the above, is there any fact or circumstance involving you or your background that would call into question your being entrusted with the supervision, guidance, and care of children and youth?

Yes No

I authorize the congregation to contact references and other congregations to obtain information about my background regarding my character and fitness for work with children and youth. I authorize references to provide such information about me. I also agree to hold harmless this congregation, its trustees, employees and volunteers. Further, I understand that a member of the staff may check the sex offender registry and/or contact local safety advocates for more information about my background. This information will be available only to those responsible for screening staff or volunteers or participating in a response team, or as required by law.

I attest that the above information is true and correct.

FCJPUU: Volunteer Application for Working with Children and Youth

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